Health Insurance for the DISABLED

Transcription

1 Health Insurance for the DISABLED

2 Why is Health Insurance required? fu'kdrtu a d LokLF; chek D; a\ A major component of Social Security that gives: Free Hospitalisation. Pre and post hospitalisation coverage. Saves from ignored or delayed treatment. A financial support for the family, to take proper care of the disabled.

3 What was happening till now? The disabled were denied Health Insurance because of their disability. Some insurances were being given at higher, unaffordable premiums. Efforts to persuade and convince insurance companies did not work. Planned to initiate national survey to collect health related data of disabled. Planned to file a PIL in Supreme Court.

4 The Big Change On April 7, 2005, The New India Assurance Co Ltd. offered to experiment Health Insurances for the Disabled without any bias, with OASiS. On November 24, 2005, modalities were finalised for the Insurances. On November 29, 2005 the first mentally challenged in the country, received Health Insurance without any extra premium and without any extra exclusion.

5 The After Effect On December 10, 2005, the Collector Bhopal announced the achievement in a press conference in Bhopal. The Collector also announced complete financial support, for health insurance premiums for all economically weaker disabled in the district. On January 7, 2006, in a workshop organized by the Collector, a survey format was designed to collect information about health and disability of the disabled, and economic status of their families. The survey format was distributed to all Block offices, and disability related NGOs in Bhopal. The filled in formats were received in March 2006.

6 The Approach The survey data was categorized on disability type, percentage, age, economic status, etc. Analysis of the surveyed data helped in identifying the frequently occurring diseases, their occurrence and expenditure, for persons with different disabilities. A workshop of medical professionals related to various disabilities was organized, to identify illnesses related to respective disabilities, and their health related requirements.

7 The Approach contd. This workshop was held in 2 stages: one with the Civil Surgeon and his team and second with the Dean of Medical College and his team. In both workshops, NGOs and CSOs working for the Disabled also participated. The discussions led to identifying the indicators for healthy living, and treatment of different disabilities, and also their therapeutic and cure requirements. This helped in scoping their Insurance cover.

8 The Approach contd. This information together with the data collected by the NGOs, gave a clear picture of the Insurance requirements of all Disabilities. It was felt, that tailoring the available health insurances would do no good, and a special insurance package is required for all PwDs. OASiS, along with other NGOs working for PwDs, approached the Chief Commissioner Disability, to bring all stakeholders together on this, and make it a national movement.

9 The Approach contd. The Chief Commissioner Disability, in the fifth National meeting of State Commissioners for PWDs in 2007, discussed this and formed a National Core Committee, to design a framework for Insurance for the Disabled. OASiS was included in this Core Group with the CCD and Chairperson National Trust heading it. Later a Task force was formed with OASiS Bhopal, AADI Delhi, Alegion (an Insurance broking Co.) from Chennai, and IRDA.

10 The Approach contd. The Task Force after rounds of discussion with IRDA, had 2 rounds of deliberations each with Actuaries of all Life Insurance, and General Insurance Cos, to get their perspective. It was a difficult task to change the mindsets of the Insurance Cos, but the data collected by the Task Force helped in convincing them. A Tender was issued by the CCDs office in December 2007, in which all Insurance Cos participated.

11 What worried us most? Will the Insurance Companies agree? What premium will they quote? How will the economically weaker disabled get insured? Will the Government spare some funds from their existing budget? What will be the framework for implementation?

12 Pleasant surprises All the Insurance Cos responded to the Tender? The premiums were varying, but worth considering? The National Trust agreed to spare some funds, from their existing budget? CCD agreed to budget this from the next financial year onwards?

13 NIRAMAYA launched Since the first year implementation was to be done by National Trust for the mentally challenged, it was decided to implement only the Health Insurance part, as their Life Insurance requirement was different. An implementation plan was designed, through the Local Level Committees of National Trust, with Alegion helping the LLCs rolling out in their districts. 10 states were chosen for the Pilot, with one District in each state. NIRAMAYA was launched on March 28, 2008 in Delhi, with advance premium for 1 Lakh economically weaker mentally challenged, paid by The National Trust.

14 What does NIRAMAYA cover? Overall Limit for Hospitalization 1,00,000/- Hospitalization 1,00,000/- Corrective surgery 50,000/- Non surgical 15,000/- Preventive surgery 15,000/- Overall Limit for Out Patient Dept. 10,000/- OPD treatment including tests 5,000/- Regular medical checkup 5,000/- On-going Therapies 7,500/- Dental Preventive Dentistry 7,500/- Alternative Medicine (IPD and OPD) 2,000/- Transportation Costs (IPD and OPD) 450/- ANNUAL INSURANCE COVER 1,00,000/-

15 Salient Features of NIRAMAYA Single premium across all ages. Same coverage irrespective of Type of Disability. All PWDs eligible. All Pre-existing conditions covered. No pre-insurance medical tests. Pre and Post hospitalization expenses covered, subject to limits. Treatment can be taken from any hospital anywhere, and costs claimed from Insurance Co. Cashless treatment at empanelled hospitals only. Scheme available in entire country, except Jammu & Kashmir. Insurance Company chosen every year. Premium for all economically weaker paid by National Trust. Annual Premium for all ages: BPL families : NIL Family Income upto Rs15000/- p.m : Rs 250/- per annum Family Income above Rs15000/- p.m : Rs 500/- per annum

16 Implementation Implemented and facilitated by Local Level Committees and Nodal Agencies in all Districts. Implemented for all 10 mental disabilities under the scope of National Trust. Both achievements and problems witnessed over the last 5 years. Procedures relooked and revamped many times to meet local challenges. Helped poor challenged get medical care.

17 Points to be noted Not implemented yet for Physical disabilities. Experience of 5 years has given us much data on claim patterns. Has changed the mindsets of Insurance Companies. Govt. of India has hopefully allocated budgets for Insurance of the Disabled across the country. If not, it can be forced upon in the forthcoming budget. Healthcare system in India is expanding and changing. Medical fraternity is also getting more aware of PWDs healthcare requirements. More service providers in the disability sector.

18 What needs to be done now? Collect state-wise data on NIRAMAYA claims. Use the framework designed by the National Core committee, for all disabilities, available with CCD office. Pressurize the Govt and Chief Commissioner Disability to implement it for all Disabilities. CDs of all states to counsel state governments to make provisions in budget for health insurances to economically weaker disabled. With the CCD, CDs of all states, National Trust and other National level bodies, lobby with IRDA for 3% reservation (life & health insurances) for the disabled. Lobby for similar reservation at State level too.

19 Together We Can Give all Disabled in the country, their right to state enabled Social Security. Pradeep Ghosh (Ashoka Fellow) Tel: , Mob: Web:

20 What does OASiS do? It is a SOCIAL INNOVATIONS LABORATORY. Identifies gaps and long standing issues in Social Sector, researches them, tries to find innovative solutions to address them, pilot them, develop them into models, and then distributes them to the Social Sector for replication. Since 2003, OASiS has developed 5 models, out of which 1 has been implemented nationally, 3 are being replicated pan-india, and 1 is at the Pilot stage. Sectors addressed till now: Social Security for rural population, Social security for Disabled, Urban education, Rural education, and Social Volunteering.